WHEN DOCTORS OPT OUT

April 17, 2009

Here's something that has gotten lost in the drive to institute universal health insurance: health insurance doesn't automatically lead to health care. And with more doctors dropping out of one insurance plan or another, there is no guarantee that you will be able to see a physician no matter what coverage you have, says Mark Siegel, associate professor of medicine at New York University's Langone Medical Center.

Doctors are turning away Medicare patients, for instance, because of the diminished reimbursements and the growing delay in payments. According to the Medicare Payment Advisory Commission, in 2008, 28 percent of Medicare beneficiaries looking for a primary care physician had trouble finding one, up from 24 percent in 2007.

The problem is even worse with Medicaid, says Siegel:

A 2005 Community Tracking Physician survey showed that only 50 percent of physicians accept this insurance.

HMOs are problematic as well; recent surveys from New York show a 10 percent yearly dropout rate from the state's largest HMO, the Health Insurance Plan of New York (HIP), and a 14 percent drop-out rate from Health Net of New York, another big HMO.

The dropout rate is less at major medical centers such as New York University's Langone Medical Center or Mount Sinai Medical Center because larger physician networks have more leverage when choosing health plans.

Bottom line: none of the current plans, government or private, provide patients with the care they need, which is increasingly expensive and requires a big battle for approvals.

However, President Obama says universal health insurance will avoid these problems, but how is that possible when you consider that the medical turnstiles will be the same as they are now, only clogged with more patients? The doctors that remain in this expanded system will be even more overwhelmed than now, concludes Siegel.